What is IVF and how does it work?

What is IVF?

IVF stands for in vitro fertilisation is one of the many fertility treatments that have been designed to support people with fertility issues getting pregnant¹. 

You might have heard of test tube babies. Well, that name was coined for IVF as in vitro stands for ‘in glass’, because the fertilisation happens in a glass petri dish, but more on that later². 

IVF has multiple steps, from ovarian stimulation to embryo transfer, lasting about 3 weeks in total.

Of all the different types of assisted conception, IVF is considered the most effective and can be performed with your partner’s sperm and your own egg or with a donor sperm or egg¹.

How does IVF work?

IVF is a multi-step procedure^1,3.

1. Fertility medication – These medications are given to you for about 10-12 days to suppress your usual menstrual cycle and stimulate your ovaries to mature multiple eggs at the same time. You will be monitored during this time with regular blood tests and ultrasounds to track the progress of your ovaries. 
2. Egg collection: Based on the ultrasound and blood results, your doctor will decide when your ovaries have produced enough eggs. When this has been determined, a ‘trigger shot’, usually of the hormone hCG is given as an injection. This triggers your eggs to fully mature in time for collection and should be given around 36 hours prior to your collection procedure. The actual egg collection lasts about 10 to 30 minutes. During this time, a small needle will be inserted through the vagina into the ovaries, under ultrasound guidance. The needle is inserted into each fluid filled sac on the ovaries which contains an egg and sucks an egg out. You will be under sedation so you won’t feel the pain of the procedure. Someone will have to collect you after the procedure as you cannot drive under sedation.
3. Sperm collection: Usually on the same day as the egg collection, a sample from your partner will be requested. If you are using donor sperm, you will pick your sample which will be prepared after the egg is collected. 
4. Fertilisation: Once the egg and sperm have been retrieved, the egg and sperm are placed in a petri dish together, waiting for fertilisation. Upon successful fertilisation, it officially becomes an embryo. This stage takes about 3-5 days.
5. Embryo transfer: The best embryo is selected and usually transferred into the uterus after 5 days. The embryo is transferred into the uterus with a thin tube with ultrasound guidance. In most cases, only one embryo is transferred, but in special circumstances, it can be two (for women over the age of 40 as it increases the chance of conception and a live birth). Sedation is not required and this step takes around 15-20 minutes.   
6. Pregnancy test – A pregnancy test is recommended after 14 days of embryo transfer. It is advised not to take the test earlier than 2 weeks as the trigger shot (which contains the same pregnancy hormone that pregnancy tests check for) needs to leave your body, to prevent a false positive result.

How successful is IVF?

The chances of a successful IVF treatment are mainly determined by age. Younger women have better IVF outcomes than older women³. 

Success rates of IVF by age in a 2019 report showed^4,5:

• Under 35 years old – 32%
• 35-37 years old – 25%
• 38-39 years old – 19%
• 40-42 years old – 11% 
• 43-44% – 5%
• Over 44 years old – 4%

What are the risks of IVF?

IVF comes with multiple risks and potential side effects⁶:

• Medication: The medications used in IVF can lead to side effects like headaches, low mood, mood swings, hot flashes and restlessness
• Multiple births: If there is more than 1 embryo transferred into your womb, there is a chance of having twins or triplets which can increase risks of miscarriage, high blood pressure, pre-eclampsia, gestational diabetes, anaemia, caesarean section (surgery to deliver the babies), premature delivery or low birth weight.
• Egg collection: Complications can be bleeding or infection but these are very rare
• Ovarian hyperstimulation syndrome (OHSS): This is a complication of IVF treatment due to sensitivity to fertility medications. In OHSS, the ovaries become large and release chemicals into the bloodstream causing fluid to build up in your abdomen. This complication usually occurs a week after egg collection presenting with pain, bloating, nausea, shortness of breath and feeling faint. OHSS can be severe and dangerous so needs to be addressed by a medical professional immediately⁷.
• Ectopic pregnancy: This is when a fertilised egg implants outside the womb, often in the fallopian tube where it cannot grow. IVF has a slightly higher risk of developing into an ectopic pregnancy. This is why IVF pregnancies have early pregnancy scans at 6 weeks to check the pregnancy is in the right place. 

How much is IVF?

Depending on where you have IVF or if it’s on the NHS, the price of IVF differs. 

How much does IVF cost on the NHS?

IVF on the NHS is of course free, but not everyone is eligible for it. The NHS has specific criteria for women aged under 40 and women ages 40-42. IVF provisions vary across the country and are determined by local policies⁸, however the NICE guidance (which is recognised nationally) is described below.

Women under the age of 40 should be offered 3 IVF cycles if you have not got pregnant after:

• regular and unprotected sex for 2 years
• 12 artificial insemination cycles, with at least 6 of them being intrauterine insemination (IUI)

Women between the ages 40 and 42 should be offered 1 IVF cycle if they meet the criteria above and all of the below:

• have never had IVF before
• tests show your ovaries will respond to fertility treatment
• you understand the complications of IVF and pregnancy over the age of 40 after discussion with your doctor

How much does IVF cost in the UK?

You can alternatively have IVF privately, but this can come with a hefty price tag. For 1 IVF cycle, the average cost is quoted to be around £5,000 but there might be additional costs for medications and tests. Some NHS clinics may offer private treatments on a not-for-profit basis. It is best to clarify with your fertility clinic the total cost before you embark on your IVF journey⁹. 

IVF FAQs 

Is private IVF quicker than on the NHS?

IVF is usually quicker privately compared to the NHS. As we know the NHS is offering a free healthcare service for the whole of the UK. This means that they may have long waiting times, which can be bypassed with private appointments. There are also strict eligibility criteria to have IVF on the NHS. If you do not meet this, private IVF would be your only option. Depending on the location, NHS waiting lists for IVF can be anywhere from months to years. 

How quickly can you get IVF privately?

The timeline for private IVF treatments depends on the clinics in your area. Due to high demand, some clinics might have longer waiting lists than others. It is best to do your research and see which clinic suits your needs and timeline. 

Finding a clinic can be tough but the Human Fertilisation and Embryology Authority has a handy fertility clinic tool to help you with your search. 

What is advised not to do during IVF? How can I help my chances of getting pregnant?

Modifying some of your lifestyle choices can improve IVF outcomes. Cutting out alcohol and smoking can increase your chances of success. We have a whole article summarising tips to improve fertility which applies to IVF as well as natural conception.

Is IVF a difficult thing to go through?

IVF can be an emotionally and physically draining procedure for both you and your partner. Cycles do not always work the first time around and many side effects come with IVF. 

Alice, a Lowdown fan, has gone through IVF and shared her experiences:

“We were trying for a child for a couple of years before lockdown and we were not getting pregnant. When I went to my GP, my fertility concerns were dismissed. After another year of trying and asking the GP for help they still refused to investigate things. I then decided to go down the private fertility testing route which indicated I had a low ovarian reserve. I then went back to the GP and was referred to the IVF clinic, which I felt was promising. However, I was told that I was too old to be eligible for IVF having just turned 36 which shocked me. To be eligible in my area, IVF treatment needed to be started 6 months before 35 years old but there was also a 2 year waiting list which baffled me. I cannot imagine how stressful and traumatic it would have been to be told this bad news and not have the means to go down the IVF route. Me and my partner had saved enough to fund 5 rounds of IVF privately. I found it tough to juggle the constant appointments, the medications, working in a male-dominated industry, and my relationship with my partner. I was fortunate enough not to have medication side effects but there was a lack of understanding from my work which made it tricky with everything going on in the background.

The emotional journey of IVF is draining. I did feel like a failure when the transfers failed and I could see the impact it had on my partner as well, though he was always so supportive. The discussions around trying another IVF cycle again were hard as we needed to factor in the financial, physical and emotional side of everything. 

My advice to people choosing IVF: Do your research and find a clinic that is specialised.  When starting, I did not understand that different fertility clinics specialise in different things, I thought it was a one size fits all. So I would advise people going down the IVF route to do their research into what they need from a fertility clinic based on their specific circumstances. Some clinics are generic and will give you a standard treatment that they give everyone. Do not put the blame solely on the female, fertility issues can be equally male related or unknown. 

Be kind to yourself and each other, you’re in it together. It is so easy to forget it at the moment but you’re doing this as a team. But if you are on your own, do not put too much pressure on yourself either, your body knows what it’s doing and will do what’s best for you 

3 failed transfers, 1 chemical pregnancy and 5 IVF cycles later, I have my beautiful baby boy and I would do it 1000 times over. But just because it is the right decision for me, does not mean it has to be for you. Understand the risks and rewards and decide for yourself, there is no right or wrong answer.”

Summary 

IVF is a fertility choice not only for those with fertility issues but single parents, same-sex couples and women who undergo egg freezing during their younger years. 

There are many considerations when deciding on a fertility treatment and type. Take your time in researching the right clinic for you if you go privately and prepare yourself for the journey ahead.